To assess the time and importance given to cardiac auscultation during internal medicine
and cardiology training and to evaluate the auscultatory proficiency of medical students
A nationwide survey of internal medicine and cardiology program directors and a multicenter
cross-sectional assessment of students' and housestaff's auscultatory proficiency.
All accredited U.S. internal medicine and cardiology programs and nine university-affiliated
internal medicine and cardiology programs.
Four hundred ninety-eight (75.6%) of all 659 directors surveyed; 203 physicians-in-training
and 49 third-year medical students.
Directors completed a 23-item questionnaire, and students and trainees were tested
on 12 prerecorded cardiac events.
The teaching and proficiency of cardiac auscultation at all levels of training.
Directors attributed great importance to cardiac auscultation and thought that more
time should be spent teaching it. However, only 27.1% of internal medicine and 37.1%
of cardiology programs offered any structured teaching of auscultation (P = 0.02).
Programs without teaching were more likely to be large, university affiliated, and
located in the northeast. The trainees' accuracy ranged from 0 to 56.2% for cardiology
fellows (median, 21.9%) and from 2% to 36.8% for medical residents (median, 19.3%).
Residents improved little with year of training and were never better than third-year
A low emphasis on cardiac auscultation appears to have affected the proficiency of
medical trainees. Our study raises concern about the future of this time-honored art
and, possibly, other bedside diagnostic skills.